Cultivated Limbal Epithelial Transplant Versus Conjunctival Limbal Auto Transplant in Uniocular Limbal Stem Cell Deficiency: Long-Term Results

Abstract

Purpose: To evaluate and compare long-term efficacy of cultivated limbal epithelial cell transplant (CLET) and conjunctival limbal autograft (CLAU) in uniocular limbal stem cell deficiency (LSCD) in chemically injured eyes. Methods: This was a retrospective, interventional, comparative study, and comprised of sixty- one patients with unilateral severe LSCD who underwent CLET (10) and CLAU (51 patients). Surgical Procedure: Surgical procedure in CLET included superficial keratectomy, excision of fibrovascular tissue, securing amniotic membrane supporting cultured limbal stem cells and placement of bandage contact lens. CLAU included superficial keratectomy, excision of fibrovascular tissue, securing limbal stem cells graft with / without amniotic membrane transplant (AMT). Results: Following CLET ocular surface improved in all 10 patients and visual acuity improved significantly in three cases. CLAU was performed in 33 eyes and combined CLAU + AMT in 18 eyes. Visual acuity improved significantly in 26 (51%) eyes. Ocular surface and symblepharon grades improved in all patients during a mean 58.7±21.9 months follow up. Conclusion: CLET and CLAU is safe and effective in rehabilitating the ocular surface before penetrating keratoplasty (PKP) in uniocular severe LSCD. CLET has the advantage of avoiding iatrogenic limbal stem cell deficiency. CLAU enabled us to repair symblepharon simultaneously by taking extra conjunctiva.